A Systematic Review of 3D-Printing in Spine Surgery: Applications, Accuracy, and Outcomes

Background: Three-dimensional (3D)-printing has increasingly been applied in spine surgery for patient-specific planning, instrumentation, and implants. This systematic review and meta-analysis aimed to evaluate the applications, technical accuracy, and outcomes of 3D-printing in spine surgery. Methods: This systematic review study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive literature search was conducted for the available literature that was published before 7 November 2024, using three medical databases (PubMed, Scopus, and Cochrane). Results: A total of 40 studies were included in this systematic review, of which 28 (70.0%) were retrospective design studies. Seven studies were included in the meta-analysis of screw placement accuracy, which showed a significantly higher probability of achieving the defined accuracy outcome with 3D-printing-assisted techniques (RR = 1.12, 95% CI: 1.06-1.19; p = 0.003). Meta-analysis of eight studies showed significantly shorter surgical time (MD = -28.97 min, 95% CI: -43.41 to -14.53; p < 0.001) and lower blood loss (MD = -80.70 mL, 95% CI: -149.92 to -11.48; p = 0.022) with 3D-printing-assisted approaches. However, substantial heterogeneity was observed for surgical time and blood loss. Conclusions: The available evidence suggests that 3D-printing-assisted approaches may improve technical accuracy and reduce surgical time and blood loss in spine surgery. However, the findings should be interpreted cautiously because of substantial clinical and methodological heterogeneity and limitations in the quality of the available evidence. Further well-designed prospective studies and randomized controlled trials are needed to confirm these findings.